Shifting Patients Causes Confusion

Police, Even Doctors, Not Told How New System Should Work

July 01, 1989|By NANCY COOK Staff Writer

NEWPORT NEWS — Shifting treatment for hundreds of patients from Riverside Regional Medical Center to the local Community Services Board has caused confusion and some hard feelings throughout the mental-health community.

Some psychiatrists who work with the patients at Riverside, as well as police officers who take patients to the hospital in emergencies, say they have not been told how the new system, which takes effect today, is supposed to work.

Some Riverside employees are also upset that after 15 years, the programs are being shifted back to the local arm of the state Department of Mental Health, Mental Retardation and Substance Abuse, Riverside officials acknowledge.

Still, said David Tate, vice president of mental health for the hospital, "It's probably gone as smoothly as it could. So many people are changing employees and the system is so complicated that there is plenty of room for friction. I don't think there is lasting friction."

Until today, Riverside's Mental Health Center held a $2.5 million contract with the Newport News-Hampton Community Services Board to provide emergency services, inpatient and outpatient services and vocational and prevention programs.

At least 1,600 patients were treated; the hospital came in contact with another 8,000 annually in the emergency room or on the telephone. The Newport News-Hampton Community Services Board was one of only a few in the state that contracted all its services out.

Chuck Hall, the board's executive director, said he is aware of the confusion surrounding the plan, but insists it is not because he hasn't informed everyone involved of his approach.

The confusion, he says, has arisen in part because police have come to rely on the hospital as a sort of "Eastern State South" for any psychiatric problems that may arise. Eastern State Hospital is the state's primary mental hospital for Eastern Virginia, but local mental-health service boards are required to screen potential patients to ensure that only those in need of hospitalization go to the James City County facility.

Also, said Hall, "The role of Riverside Emergency in treating the mentally ill is not clear now."

His plan calls for a staff of 83 to take over all the programs, including providing 24-hour, on-the-spot crisis counseling for emergencies like the hundreds that police routinely handle each year.

Much of the consternation over the change stemmed from the fact that until this week, police thought Riverside would be closing a holding room in its emergency center, where violent or dangerous patients could be held until treated by psychiatrists.

Tate said that room, as well as Riverside's open-door policy to any patients the police bring in, will remain open to ensure that the confusion does not result in poor medical care for those in need.

In addition, at least 31 of Riverside's employees have been hired by Hall to ease the transition.

Police Chief Jay A. Carey said Friday there is less confusion surrounding the plan now than a week ago. He said details of new procedures have been sent to all supervisors and are being outlined to police as they go on duty.

"I'm not critical," he said. "I realize this is not an easy thing to accomplish."

Two police officers who asked not to be identified said the new procedure for handling psychiatric crises has not been explained to them or their colleagues.

"The basic police officer does not know what he will do after Saturday," said one officer, who said he often handles arrests that involve psychiatric crises.

Psychiatrists who work with Riverside also said they are uncertain as to the new approach.

"Six months have gone by and one would have hoped a clear-cut plan would have been devised," said Dr. Rudolph Freeman Jr.

"My only concern as a mental-health professional is to make sure these pations don't fall through the cracks," he said. "And all we know is July 1, there will be a change."

Paul Gilding, a community-services board liaison with the state, said he does not understand the confusion. "We've been apprised every step of the way." He suggested some of the confusion is to be expected, considering the massive change involved.

Riverside initially approached Hall about taking over a few facets of the mental health services the Community Services Board has contracted to the hospital last year. Hall said that after reviewing the services, and the costs involved, he thought the board could better serve its patients by running the programs itself.

Riverside will continue its mental health programs, only on a much smaller scale, for clients that can afford to pay, Tate said. Others will be referred to the state-run programs.